EXECUTIVE SUMMARY
Clinicians’ complaints about registration wait times might be unfounded, or they might misunderstand the role of patient access. Some effective responses include the following:
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Determine the average wait time.
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Obtain support from clinicians for needed improvements.
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Inform clinicians that patient access staff members act as financial counselors and ensure that revenue isn’t lost.
“How come you are asking so many questions? I need you to register this person now!” While well-meaning, such statements made by clinicians often are unfounded.
“We have had issues where clinical departments have stated that patients have to wait too long to register,” says Laura King, access manager at Valley View Hospital in Glenwood Springs, CO.
The patient access department did a time period study to show the times patients arrived and how long it took to register. This study showed that the average wait time was only three minutes. “There was just an assumption that it took too long to register patients,” says King.
She says that if a clinical department is complaining about patient access, the best solution is to monitor the situation and come up with some hard data. “Either show that there is not an issue, or improve the problem,” advises King.
In outpatient registration areas at Brookhaven Memorial Hospital Medical Center in Patchogue, NY, patient access orders all bloodwork and radiological tests. Kimberly Horoski, MBA, MHA, department head of patient access, says, “Clinicians commonly complain about the time it takes to enter orders after registration.”
If there is any type of delay, clinicians blame patient access for it. “The best part of electronic charting and records is that there is a timestamp on all orders. Once entered, the time is reflected,” says Horoski.
Why settle for offering vague assurances that patient access is working as quickly as possible, when timestamps show exactly when they completed registration? “This helps clinicians see that perhaps the delay is not my staff,” Horoski says. It’s possible that the patient was at a test or getting blood drawn because clinicians wrote orders before full registration was completed.
If the timestamp shows a larger-than-expected delay, patient access staff can be held accountable. The timestamp also might show that, in fact, registrars are working as quickly as they possibly can. “The influx and numbers of patients coming in may be much more than the number of staff we have on that day can handle,” says Horoski.
She uses the ED registration system to obtain the average time it takes from the completion of quick registration, when registrars verify only the patient’s name, date of birth, and reason for being at the hospital, to the completion of full registration. “Removing the average time it takes to do triage gives you the average registration time,” Horoski says.
Next, Horoski runs time studies to validate the numbers. “I ask staff to give me the time the patient was started on full registration until they were finished with all facets of the registration and see how the times line up,” she says. This analysis allowed the department to come up with an average turnaround time for registration. “We were able to see what staff were meeting, exceeding, and lacking on the quota,” she says. Horoski created an electronic spreadsheet showing the average time it takes each associate to do a registration.
If registration times are too long, Horoski says there are two possibilities:
• Workflow is the problem.
In this case, patient access leaders should try to get support from clinicians to get time-saving resources, such as electronic signatures or portable computers with scanners so that registration can be done at the bedside. “They can support the organization making large operations costs, like gaining new equipment for the patient access staff or more labor to cover the volume,” says Horoski.
• Individual registrars are taking too long.
The first step is to track wait times by individual registrar. “Any main outliers need to be removed. Then look at the average,” says Horoski.
Patient access managers should speak to registrars who are far over the average in time. “Find out their barriers; then they should be monitored,” says Horoski. Inadequate staffing or staff members not working to the best of their ability are two common barriers. “Another barrier could be slow equipment that does not work as fast as staff,” she says.
Patient’s Best Interest
Keep in mind that clinicians have the patient’s best interest at heart when expressing concerns about registration wait times, Horoski says.
“This is certainly understandable, and the core measures dictate this need, since so many medical issues are time-sensitive,” she says, referring to standardized best practices to improve the quality of care, reported to The Joint Commission and CMS.
Clinicians don’t always realize that the role of patient access is to ensure that their hard work is paid for, however. “Explain to clinicians what patient access brings to the table,” urges Horoski. She suggests telling them the following:
Horoski says clinicians often do not realize that patietn access employees do the following tasks as part of their jobs:
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Patient access obtains important demographic and insurance information, and staff members explain important mandatory forms for registration.
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Patient access staff members are the financial counselors of the ED and work with patients who may have difficulty paying their bills.
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The questions that patient access asks are all important for different reasons.
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Ask for emergency contacts.
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Determine insurance eligibility.
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Obtain email addresses so patients can access the patient portal.
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Ask race and ethnicity questions.
“Patients are our number one priority,” emphasizes Horoski. “That is for clinicians and patient access alike.”
SOURCES
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Kimberly Horoski, MBA, MHA, Department Head of Patient Access, Brookhaven Memorial Hospital Medical Center, Patchogue, NY. Phone: (631) 654-7769. Fax: (631) 447-3082. Email: [email protected].
